The success of Physician Advisor (PA) programs in quality improvement, margin protection and regulatory risk reduction has led to the identification of measureable metrics to evaluate and monitor a PA program. This article will provide an overview and examples of how to measure success and how to use metrics to sustain improvements.

In the 2017 Inpatient Prospective Payment System (IPPS) proposed rule (CMS-1655-P) the Centers for Medicare and Medicaid Services (CMS) requested input on ideas that would make regulations less burdensome and more transparent. We appreciate this effort. Our “all inpatient” proposal is aligned with these goals.

The American College of Physician Advisors (ACPA) appreciates the opportunity to respond to your RFI soliciting ideas to better achieve transparency, flexibility, program simplification, and innovation in the administration of Medicare Part C.

Comprehensive yet pertinent documentation is critical within the medical record. Far beyond coherent communication of data and insight between medical providers caring for a patient, good documentation also allows for accurate representation of patient severity in quality data, and appropriate coding, billing, and reimbursement.

Most of us understand the Medicare Two-Midnight Rule. Whether anticipation of two midnights of medically-necessary care in the hospital at the time of admission, or expectation of a second, medically-necessary midnight the day following admission after a first midnight has passed, we get it. For the most part, it’s become pretty engrained in our psyche.

Now that most health systems are aware of the profound, positive impact a physician advisor can make in the case management, utilization, and clinical documentation improvement (CDI) arenas, hospitals are scrambling to find the perfect candidate. This search inevitably begins with one question: “Hire from within, or recruit an outsider?”